NURS9124 Assessment 2 Critical Evaluation Essay

Introduction: 

Communication refers to exchanging information with the help of different mediums, such as speaking, writing, or body language. It is of great importance in the field of medicine. The selected communication process which I believe needs to be improved in my workplace is patient and healthcare provider (mainly nurses) communication (Kwame & Petrucka, 2021). Tiwary et al. (2019) stated that patient-provider communication is a technical aspect of healthcare and a cornerstone of quality care. Effective physician-patient communication is significant as it is related with favourable health outcomes such as increased patient satisfaction, compliance, and overall health status. Patients often experience anxiety and fear while communicating, which may result in misunderstanding (Tiwary et al., 2019). However, effective communication between patients and healthcare providers, mainly between nurses and patients, can ensure that both are on the same page regarding treatment plans, medications, and post-treatment plans (Kwame & Petrucka, 2021). The current aims to critically evaluate the patient and provider communication process evident in my workplace with clearly identifying related issues, questions, or problems. Further, the essay will demonstrate the nature of critical thinking and the element of thoughts. Lastly, subsequent improvements that could be made to the communication process will be provided.

Body:

The chosen communication process is the interaction between patients and nurses in the healthcare setting. During my clinical practice in the general ward of the hospital, I noticed a lack of effective communication between nurses and patients, which resulted in severe consequences like ineffective assessment and medication errors. The value of effective communication in nurse-patient clinical interactions cannot be overemphasized. It has been reported that communication is essential for more accurate patient reporting and disclosure (Tiwary et al., 2019). Kwame & Petrucka (2021) stated that respectful communication between nurses and patients can reduce uncertainty, enhance greater patient engagement in decision-making, improving patient adherence to medication and treatment plans, and increase social support, safety and patient satisfaction in care.

What are the issues, questions or problems related to the nurse and patient communication process?

Nurse-patient communication is a critical component of healthcare; however, several issues, questions, and problems can arise in this context. Addressing these challenges is essential for providing high-quality care and ensuring patient satisfaction. Here are some common issues and questions related to nurse-patient communication (Boström et al., 2022). One of the common issues is language barriers, which occur when people do not speak the same language or do not have the same level of ability in a language. The most obvious and immediate challenge is that patients may not fully understand the information provided by the nurse. Miscommunication due to language barriers can lead to patient safety issues. Patients may not understand medication dosage or side effects, which can result in medication errors (Wune et al., 2020).

Additionally, patients may not be able to communicate allergies or previous adverse reactions to specific treatments. Studies indicated that unsuccessful patient-to-nurse communication results in prolonged hospital stay, more resource expenditure, patient disappointment as well as a lack of self-assurance and frustration for both the nurses and the patient (Kwame & Petrucka, 2021). Obtaining an accurate medical history is essential for diagnosis and treatment planning. Ineffective communication between nurses and the patient can result in inadequate assessment. When the patient cannot effectively communicate their symptoms, medical history, and concerns due to language barriers, it can hinder the nurse's ability to make informed decisions (Wune et al., 2020). 

Critical thinking and elements of thoughts: 

Critical thinking can be defined as the mode of thinking about any subject, content or problem in which the thinker improves the quality of his/her thinking by skillfully taking charge of the structure (Von Colln-Appling & Giuliano, 2017). The Paul-Elder Critical Thinking Framework plays a important role in encouraging effective nurse-patient communication by providing a structured method to thinking critically, which is important for clear, thoughtful and empathetic communication (Papathanasiou et al., 2014). Paul & Elder (2019) inspires nurses to reflect their own perspective, making them conscious of their biases and expectations that might hinder effective communication. By identifying these potential barriers, nurses can work to overwhelmed them and communicate more efficiently. The application of critical thinking in nursing practice is helpful in the procedure of solving difficulties of patients and the decision-making procedure with inspiration to improve the effect (Abdulla et al., 2021). 

The elements of thought, as defined in the Paul-Elder Critical Thinking Framework, can be applied to endorse effective nurse-patient communication. According to the first element, i.e., purpose and precision, nurses should have a clear purpose for each communication interface with patients. Whether it is explaining a procedure, discussing a diagnosis, or providing instructions, knowing the specific purpose safeguards focused and applicable communication (Papathanasiou et al., 2014). Meanwhile, the application of the second element (Questions at issue) and the third element (information) of Paul & Elder (2019) can help endorse the critical thinking of nurses. Nurses should ask open-ended questions to discover patient's perspectives and needs, development more collaborating and engaging communication. Additionally, nurses should ensure that the information shared is personalized to the patient's needs and understanding. Nurses should only use jargon and medical terminology if the patient is well-informed. The fourth element of Paul and Elder (2019) can be applied in nursing practice to endorse communication with patients. Nurses should deliberate the patient's response and non-verbal cues to make inferences about their anxieties or emotions (Paul and Elder., 2019). 

The use of the fifth element of Paul & Elder (2019) is based on data, information and evidence collected to provision the use of effective communication between nurses and patients. The existing studies, including the study by Tiwary et al. (2019) and Kwame & Petrucka. (2021), and Wune et al. (2020) supported the importance of effective communication between nurses and patients to encourage the quality of care delivered. By using the data collected and evidence provided by reliable existing studies, nurses can use clear and consistent terminology when deliberating medical concepts. Nurses should understand the barriers and facilitators which they face during patient communication (Wune et al., 2020). The evidence collected showed that different demographic characteristics, cultural and linguistic barriers, lack of knowledge, and different belief system of patients and caregivers acts as a barrier to therapeutic communication and care (Paul and Elder., 2019). 

Further, the use of the sixth element, which is states identifying key concepts and ideas and explaining them clerkly, can be helpful in developing reasoning abilities. To promote effective communication, nurses should understand the key concepts like explaining diagnosis, treatment, and care plan in simple language without medical jargon (Von Colln-Appling & Giuliano, 2017). Another element works for inferences or interpretations of the evidence collected. To interpret the effectiveness of communication by considering the intended purpose. As the goal is to overcome the barrier nurses face in effective communication with patients, it can be evaluated by identifying patient satisfaction and care outcomes. Lastly, the eight elements can be used to draw a conclusion which summarizes key points of the communication and ask the patients to restate important information to ensure they have understood it correctly (Von Colln-Appling & Giuliano, 2017). 

Improvements that could be made to the communication process: 

Interventions can be implemented to improve nurse-patient interaction, which is crucial for enhancing the quality of care, patient satisfaction, and overall health outcomes. This can be done by providing communication skills training, the training should cover active listening, empathy, effective questioning and delivering difficult news with compassion (Burgener, 2020). The training program should be developed for several weeks to allow for in-depth learning and clinical application. During training, nurses should be trained to develop active listening skills to improve understanding of patient needs and enhance empathy and emotional intelligence in communication. When patients generally face anxiety and fear of being judged during assessments, to overcome these barriers, nurses should follow a patient-friendly manner (Yazdanparast et al., 2021). This can encourage the patients to share the right information without any fear and also allows nurses to improve their ability to convey complex medical information in a clear way (Kandaswamy et al., 2020).

When nurses lack the understanding about cultural competence and diversity it results in less effective nurse-patient interaction. Nurses should enroll in courses which can promote their understanding about the role of culture and its impact on communication (Yazdanparast et al., 2021). Some of the strategies can be followed to learn cultural competence, like involvement in role-play scenarios involving cultural competence and learning from the case studies. Cultural competency trainers or guest speakers can help nurses by sharing relevant information and guiding nurses about techniques like de-escalation and conflict resolution (Abdulla et al., 2020). 

Another recommendation for nurses is self-assessment; nurses should reflect on their own communication strengths and weaknesses. This can help nurses in identifying the areas of practice and allow them to set goals for self-improvement (Yazdanparast et al., 2021). According to the study by Kerr et al. (2020), some of the prevalent barriers faced by nurses include feeling unskilled to having a difficult conversation with patients who have a life-limited illness and some organizational factors like report being hampered by time restraints and lack of information about the patient's condition and goals of care. Nurses should collaborate with other healthcare professionals, such as social workers, interpreters, and physicians, to learn about their roles and communication styles. This interprofessional education can help nurses to work together more effectively and overcome the organizational barriers. Nurses can pursue for peer support by connection or making support groups, such as nurse forums or discussion groups. These groups can encourage the sharing of good and bad experiences and allow them to grow new strategies for effective communication. Nurses should stay efficient with literature and resources on communication in healthcare. Books, articles and other reliable online resources can deliver insight to nurses into best practices and the latest research in the area of effective communication (Kerr et al., 2020). 

Changes required to happen in the workplace to advance the communication process: 

As mentioned in the study by Kerr et al. (2019), organizational factors can also impact the communication process between nurses and patients. To improve the communication process in the workplace, some of the changes are needed. The healthcare organization should establish clear communication standards within the workplace. Ensure that all staff members, including nurses, follow these standards (Kerr et al., 2019). These standards should include the use of plain language, avoiding medical jargon, and ensuring that information is easily understandable by patients. Mentors and supervisors should be appointed in the workplace who can supervise the actions of nurses and also guides them whenever needed (Wang et al., 2020). The workplace should promote the use of health information technology, which are efficient and user-friendly like electronic health records (EHRs). Kandaswamy et al. (2020) mentioned that communication failure in healthcare leads to the majority of sentinel events that occur in hospital, and 38% of malpractice incidents involve miscommunication between providers (Kandaswamy et al., 2020). The healthcare organizations should encourage the use of EHRs as it enables nurses with immediate access to a patient’s whole medical history, counting past treatments, medications, allergies, and test results. This complete information allows nurses to have a more informed conversation about the patient’s current condition and treatment plan with their colleagues. EHRs help nurses accomplish medications more efficiently by delivering up-to-date evidence on a patient’s prescription history and potential drug interactions (Kandaswamy et al., 2020). This information is dynamic for confirming safe medication management and for communicating medication plans with other team members. The workplace should launch a feedback mechanism for patients to deliver input on their communication experiences with nurses. Nurses should use this feedback to make developments and assess nurse-patient communication skills (Kerr et al., 2019). 

Conclusion: 

In conclusion, it can be stated that effective communication between nurses and patients is a important aspect of healthcare delivery, meaningly impacting patients’ consequences, satisfaction, and overall quality of care. In this essay, we have deliberated the significance of improving the nurse-patient communication process, recognized key issues and challenges, and explored the role of critical thinking and the elements of thought in promoting communication. Issues such as language barriers, lack of cultural competence, ineffective assessment and misunderstanding have been highlighted. The Paul-Elder Critical Thinking Framework offers a structured approach to critical thinking, which is essential for clear, thoughtful, and empathetic communication. The elements of thought, when applied in the framework of communication, it can help nurses ask meaningful questions, gather and interpret relevant information, and reach informed conclusions. To improve nurse-patient communication, numerous strategies like communication skills training, cultural competence education, self-assessments, interprofessional collaboration and staying updated with the latest research in healthcare communication can be implicated. Additionally, organizational changes, such as establishing clear communication standards, promoting the use of EHRs, and implementing a feedback mechanism for patients can create a supportive environment for effective nurse-patient communication. 

Reference: 

Abdulla, N. M., Naqi, R. J., & Jassim, G. A. (2022). Barriers to nurse-patient communication in primary healthcare centers in Bahrain: Patient perspective. International Journal of Nursing Sciences, 9(2), 230-235. https://doi.org/10.1016/j.ijnss.2022.03.006 

Boström, E., Ali, L., Fors, A., Ekman, I., & Andersson, A. E. (2020). Registered nurses’ experiences of communication with patients when practising person–centred care over the phone: a qualitative interview study. BMC Nursing, 19, 1-8. https://doi.org/10.1186/s12912-020-00448-4 

Burgener, A. M. (2020). Enhancing communication to improve patient safety and to increase patient satisfaction. The Health Care Manager, 39(3), 128-132. https://journals.lww.com/healthcaremanagerjournal/abstract/2020/07000/enhancing_communication_to_improve_patient_safety.4.aspx 

Kandaswamy, S., Hettinger, A. Z., Hoffman, D. J., Ratwani, R. M., & Marquard, J. (2020). Communication through the electronic health record: frequency and implications of free text orders. JAMIA open, 3(2), 154-159. https://doi.org/10.1093/jamiaopen/ooaa020 

Kwame, A., & Petrucka, P. M. (2021). A literature-based study of patient-centered care and communication in nurse-patient interactions: barriers, facilitators, and the way forward. BMC Nursing, 20(1), 1-10.https://doi.org/10.1186/s12912-021-00684-2

Paul, R & Elder, L. (2019). The miniature guide to critical thinking concepts and tools. 

https://www.criticalthinking.org/files/Concepts_Tools.pdf

Papathanasiou, I. V., Kleisiaris, C. F., Fradelos, E. C., Kakou, K., & Kourkouta, L. (2014). Critical thinking: the development of an essential skill for nursing students. Acta Informatica Medica, 22(4), 283. https://doi.org/10.5455%2Faim.2014.22.283-286

Tiwary, A., Rimal, A., Paudyal, B., Sigdel, K. R., & Basnyat, B. (2019). Poor communication by health care professionals may lead to life-threatening complications: examples from two case reports. Wellcome Open Research, 4.https://doi.org/10.12688%2Fwellcomeopenres.15042.1

Von Colln-Appling, C., & Giuliano, D. (2017). A concept analysis of critical thinking: A guide for nurse educators. Nurse Education Today, 49, 106-109. https://doi.org/10.1016/j.nedt.2016.11.007 

Wang, Y. Y., Wan, Q. Q., Lin, F., Zhou, W. J., & Shang, S. M. (2018). Interventions to improve communication between nurses and physicians in the intensive care unit: An integrative literature review. International Journal of Nursing Sciences, 5(1), 81-88.https://doi.org/10.1016%2Fj.ijnss.2017.09.007

Wune, G., Ayalew, Y., Hailu, A., & Gebretensaye, T. (2020). Nurses to patients communication and barriers perceived by nurses at Tikur Anbessa Specilized Hospital, Addis Ababa, Ethiopia 2018. International Journal of Africa Nursing Sciences, 12, 100197.https://doi.org/10.1016/j.ijans.2020.100197

Yazdanparast, E., Arasteh, A., Ghorbani, S., & Davoudi, M. (2021). The effectiveness of communication skills training on nurses' skills and participation in the breaking bad news. Iranian Journal of Nursing and Midwifery Research, 26(4), 337.https://doi.org/10.4103%2Fijnmr.IJNMR_150_20

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